Make the Diagnosis: Fall 2020

KD is a 14-year-old female with no prior medical history who presents to your outpatient office with a 6-month history of generalized abdominal pain that has been increasing in frequency over time. The pain is crampy in nature and does not radiate. She also has between 2 to 4 loose and non-bloody stools daily, which is a change from her baseline stool characteristics. Her pain does not typically improve after defecation. Her appetite is inconsistent and she has intermittent nausea. The symptoms seemed to coincide with the start of the current school year, her freshman year of high school. She has been taking lactobacillus every day for the past month without any change in symptoms. Although her sleep has been affected periodically by pain and bowel movements, she continues to do very well academically and has not missed class due to symptoms. She lives with her mother and spends weekends with her father, as they separated 8 months ago.

She does not have any tenderness on exam or organomegaly. Her perianal and rectal examination is unremarkable. Growth parameters show no weight gain from her well-child exam 2 years prior, but an appropriate increase in height. She has a slight unspecified anemia. Stool studies for common enteric pathogens were negative.

Have you figured out this diagnosis? It was inflamatory bowel disease, the subject of this issue’s cover article.

Immaculate Fabros, MD, of New South Wales, Australia, submitted the first correct answer to last issue’s Make the Diagnosis challenge. It was acute food protein-induced enterocolitis, the subject of this issue’s cover article.